Suggestions for Health Sector Reform in Trinidad and Tobago

Health reform refers to the changes in health administration, health planning and, health research that places significant emphasis on local health challenges aimed at improving health administration, health planning and healthcare. They will combine to produce an efficient model of healthcare delivery capable of increasing patient physical, medical and psychological safety. Health reform should be driven by empirical data, best practice and evidence based practice. A variety of health statistics; such as mortality, manpower needs, technology functioning and patient satisfaction; should be analyzed and employed in strengthening health systems.

In Trinidad and Tobago the current system of healthcare is highly centralized. The Ministry of Health maintains operational oversight of five regional health authorities. These are the North West Regional, North Central Regional, Eastern Regional, South West Regional and Tobago Regional. South West, North West and North Central are the largest regions; each catering for the healthcare needs of more than three hundred thousand people.

A significant reform should be the specialization of the Ministry of Health in fewer functions aimed to improve healthcare efficiency. For example, it can concentrate on data compilation and analysis. It should be staffed with expert health researchers tasked with analyzing changes in epidemiology, and trends in morbidity and mortality. Furthermore, the Ministry of Health should have the power to instruct regional authorities to make systemic and resource changes based on the statistics collected and analyzed. Regional bodies should be mandated to provide health based statistics to the Ministry of Health quarterly. The Ministry of Health must maintain general oversight of regional authorities. It should produce annual reports based on self- monitoring and evaluation of the systems, performances and challenges in each region. Financial statements and audits should be submitted annually to the Ministry of Health and factors accounting for variance should be justified. Recommendations should be made for improvements and incidences of white-collar crime prosecuted.

One major reform that should be implemented is granting absolute autonomy to regional health authorities for the delivery of healthcare. They should be able to generate their own funds by charging fees for their services. This would eliminate dependency on the state or Ministry of Finance for funding. Each regional health authority should be able to invest in the stock market or undertake other income generating measures it deems feasible. Its funds should be spent in accordance with the health needs of the population it serves. Regional authorities should be responsible for primary, secondary and tertiary healthcare. In addition, they should be given oversight of private hospitals and health facilities in their geographic regions. Private facilities should be subject to price controls to avoid exorbitant charges and should be required to pay at least ten percent of their annual profit to the regional authority.
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